Abstract
OBJECTIVES: The 8th edition of the American Joint Committee on Cancer classification system defines the postneoadjuvant pathological T0-2N0M0 (ypT0-2N0M0) stage as ypI for oesophageal cancer. This study was designed to explore the possible differences in survival among patients with yp stage I. METHODS: The records of patients with oesophageal squamous cell cancer staged ypI who underwent a radical oesophagectomy between July 2009 and July 2022 at the Sun Yat-sen University Cancer Center were reviewed. The survival differences were compared between ypT0, ypTis, ypT1a, ypT1b and ypT2. RESULTS: A total of 355 patients (65 deaths and 34 recurrences) were reviewed. Overall survival (OS) and disease-free survival (DFS) differed significantly between patients in the total population staged as ypT0-1a and ypT1b-2 [5-year OS (5-OS): 81.5% vs 70.2%, P = 0.043; 5-year DFS (5-DFS): 80.8% vs 71.9%, P = 0.016) in the neoadjuvant chemoradiotherapy (NCRT) group (5-OS: 82.0% vs 67.5%, P = 0.032; 5-DFS: 84.6% vs 71.2%, P = 0.027), but not in the neoadjuvant chemotherapy±I group (5-OS: 80.3% vs 72.9%, P = 0.34; 5-DFS: 66.5% vs 72.4%, P = 0.41). The OS and DFS of patients with ypT0 stage (pathological complete response) disease were similar to those of patients with ypTis-1a disease in the total population (P = 0.16 and 0.94) and the NCRT group (P = 0.40 and 0.57). Cox regression analysis revealed that ypT1b-2 was an independent prognostic factor for survival in the total population (hazard ratio = 1.760, 95% confidence interval = 1.056-2.933; P = 0.030). CONCLUSIONS: Patients with ypIa-new (ypT0-1aN0M0) disease had significantly better survival than those with ypIb-new (ypT1b-2N0M0) disease among patients who received NCRT. Patients with ypIa-new (pathological complete response and ypTis-1aN0M0) disease had similar survival data. Adjuvant immunotherapy might not be required for patients with ypTis-1aN0M0 stage disease.